I will be back in a couple of weeks I suffered major life threatening health issues and took a disability. I want to thank everyone for your prayers.
Tuesday, September 1, 2015
Friday, December 18, 2009
Personal Reasons
Sorry I have not posted for a while. I have been diagnosed with Rheumatoid Arthritis and have been working with medications to get stabilized. I am back on board now and ready to get back to this business of informing others about what's going on in the healthcare industry. Stay tuned for my next blog this weekend. Thanks for your patience.
Sunday, August 16, 2009
The Bounty Hunters
Medicare's recovery audit contractor (RAC) program, the "bounty hunter program," is now a permanent entity. As the Medicare program is facing $34 trillion in unfunded liabilities, it is clear that government has promised more in Medicare benefits than taxpayers can afford long-term.
Although physicians currently face a 21 percent cut in Medicare fees in 2010, government is looking to take more money back from physicians via aggressive "bounty hunting" to help slow the financial demise of the Medicare program.
Amazing the insurance companies are taking from the physicians with constant denials and offering new contracts with lower reimbursements rates and yet the physicians are expected to operate financially as usual. The physician has no place to go to cut costs.
Now we have to deal with RAC. Aggressive RAC attacks are anticipated, and physicians will be targeted for substantial repayments in the coming years. Section 306 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 authorized a 3-year RAC demonstration project. The demonstration program began in March 2005 and ended on Mar 27, 2008.
Section 302 of the Tax and Health Care Act of 2006 authorized the creation of a permanent RAC program to be expanded to all states by 2010. All physicians in all states will be vulnerable to RAC attacks under the permanent RAC program. What can practices do to protect themselves?
Make sure you stay compliant with Medicare billing Regulations by reviewing your current billing and compliance policies to ensure you are in line with Medicare Regulations. According to the Centers for Medicare and Medicaid (CMS), a Recovery Audit Contractor may demand repayment of a claim without reviewing your medical records in the following situations:
1. A statute, regulation, or national or local coverage determination rules reimbursement for a service will always be an overpayment.
2. The service is found to be a medically unnecessary service.
3. Your practice fails to respond timely to a demand letter requesting medical records.
There are many various companies for hire to do pre-audits for your practice. However you can perform your own pre-audit within your practice to identify areas of risk that might be a red flag if an automated review is performed on your patient records and billing.
For more information review the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Work Plan and review the RAC’s website that is covering your geographic region.
Although physicians currently face a 21 percent cut in Medicare fees in 2010, government is looking to take more money back from physicians via aggressive "bounty hunting" to help slow the financial demise of the Medicare program.
Amazing the insurance companies are taking from the physicians with constant denials and offering new contracts with lower reimbursements rates and yet the physicians are expected to operate financially as usual. The physician has no place to go to cut costs.
Now we have to deal with RAC. Aggressive RAC attacks are anticipated, and physicians will be targeted for substantial repayments in the coming years. Section 306 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 authorized a 3-year RAC demonstration project. The demonstration program began in March 2005 and ended on Mar 27, 2008.
Section 302 of the Tax and Health Care Act of 2006 authorized the creation of a permanent RAC program to be expanded to all states by 2010. All physicians in all states will be vulnerable to RAC attacks under the permanent RAC program. What can practices do to protect themselves?
Make sure you stay compliant with Medicare billing Regulations by reviewing your current billing and compliance policies to ensure you are in line with Medicare Regulations. According to the Centers for Medicare and Medicaid (CMS), a Recovery Audit Contractor may demand repayment of a claim without reviewing your medical records in the following situations:
1. A statute, regulation, or national or local coverage determination rules reimbursement for a service will always be an overpayment.
2. The service is found to be a medically unnecessary service.
3. Your practice fails to respond timely to a demand letter requesting medical records.
There are many various companies for hire to do pre-audits for your practice. However you can perform your own pre-audit within your practice to identify areas of risk that might be a red flag if an automated review is performed on your patient records and billing.
For more information review the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Work Plan and review the RAC’s website that is covering your geographic region.
Friday, July 10, 2009
Enough Already About Socialized Medicine!
Once again I find myself writing about the term "Socialized Medicine". I hear it every single day on television, on the radio and from people in the breakroom at the medical practice where I am employed. I doubt most people know what the term really means. Yet it has become a catch all phrase for what President Obama wants to do to improve our present day health care system. Let's face it. Our present system is in dire straits and needs change. The term Socialized Medicine is used to describe a system of publicly administered national health care.
Of all the major industrialized nations, the United States ofAmerica is the only one whose citizens do not enjoy the benefits and security of a universal comprehensive health care system.
Yet long before there was Medicare and Medicaid, many people of modest and low income received decent medical care through fraternal organizations. Lodges would sign contracts with doctors, in effect buying services in bulk that, throughout the year, would be distributed to members and their families at affordable prices. The system made medical care accessible while maintaining self-responsibility and cost-consciousness. However that has gone by the wayside or now is know as Coinceirge Medicine and practiced today by the wealthy. But we are not concerned with the wealthy at the moment this whole thing got started because the high cost of insurance has become prohibitive to not just the poor but the middle class as well.
Some of us do not understand the implications of a national health plan and are alarmed when we hear the words socialized medicine or national health plan, some out of ignorance and others on the grounds that the program will be costly and will lessen the quality of patient care not to mention the number of physicians who may find new ways to make a living. These same sentiments were especially visible during the Clinton Administration's failed attempt to implement a national health care plan. And now with the Obama administration we find ourselves hearing the same complaints.
I have heard people complaining about the extra cost and added taxes it would place on the people. Well and I am not saying I agree or disagree but wouldn't the added taxes that would be collected, replace insurance premiums, deductibles, co pays, and balanced billings? Could it be that on average, the amount of tax paid would be less than what individuals and families now pay for their health coverage? Is this true or not? I guess that would take a little investigative research on my part.
A large segment of our population worry about how it would affect their current coverage if President Obama has his way and we go with a type of universal health plan. What will happen to my Medicaid? Why nothing as far as I can tell since the system covers everyone, Medicaid would be unnecessary. What will happen to my Medicare ? Again Medicare would be unnecessary since everyone will be covered. It would definitely (I think now I haven't done a whole lot of research) be a life saver for the Self Employed since all citizens are covered. As it stands at present, small businesses would not suffer with large premiums because they have a small number of employees and it would no longer be a concern. As far as the big businesses are concerned it is my understanding that they will not be allowed to just arbitrarily drop their plans. Also, if you are happy with your present coverage you can keep it as well as the physician of your choice.
Of the top twenty four industrialized (modern)nations, the U. S. ranks twenty-first in infant mortality and sixteenthin life expectancy. Yet we spend more than 40 percent more per capita on health care than any other nation. And over 45.7 million Americans today are without any health care insurance, which means, of course, that many of us go without routine health care and so must frequent emergency rooms to obtain any help, a treatment which is much more costly than it would otherwise be. The other day I read that 60% of Bankruptcies filed in the United States are because of Medical bills. Ridiculous system, unfair system; there is no excuse for such a system in this day and age.
Some politicians say the system will end up like present day Medicare with a shortage of funds and then we will really be in trouble. How could our government run such a system just look at the trouble Medicare is in now with rampant fraud? Well I think fraud is something that goes on all the time in every program until we learn to put in better risk management systems. The truth is less than 3% of Medicaid or Medicare costs goes for administration. This low level of cost for the administration of two very large programs shows that the government can efficiently manage large programs.
In "socialized medicine," as in Sweden and Great Britain, doctors are salaried civil servants and the government itself (that is,the citizens) owns and operates most of the hospitals, with some others being run by non-profit organizations. With a "single-payer," or national health insurance plan, doctors are in private practice and most hospitals are not government owned and operated. Doctors and hospitals,as well as pharmaceutical and medical device companies, must negotiate their fees and charges with the government agency in charge of financing the plan and articulating its organization. In regard to the costs of drugs especially, this centralization is one of the reasons health carecosts are lower in single-payer systems, and it also explains why drug companies fight so hard against any single-payer plans. Does that really sound that bad a deal?
I know it will probably hurt the Pharmaceutical and health insurance industry but right now it seems the insurance industry is the only industry that is not hurting in our economy. Where is the justice in an industry in which the insurance companies are allowed to raise premiums, lower benefits and make obscene profits and bonuses in the millions to their CEO's. Yes, large numbers will lose their jobs in the insurance industry and also many assistants and lobbyists necessary to the administration of insurance industries' interests. However I am sure new jobs and industries will emerge to handle the change in the industry on this you can count on. Of course Physicians for a National Health Program say that by streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans. So I say enough already about socialized medicine let's do our research and pay attention and try and come up with what is best for all of us!
Of all the major industrialized nations, the United States ofAmerica is the only one whose citizens do not enjoy the benefits and security of a universal comprehensive health care system.
Yet long before there was Medicare and Medicaid, many people of modest and low income received decent medical care through fraternal organizations. Lodges would sign contracts with doctors, in effect buying services in bulk that, throughout the year, would be distributed to members and their families at affordable prices. The system made medical care accessible while maintaining self-responsibility and cost-consciousness. However that has gone by the wayside or now is know as Coinceirge Medicine and practiced today by the wealthy. But we are not concerned with the wealthy at the moment this whole thing got started because the high cost of insurance has become prohibitive to not just the poor but the middle class as well.
Some of us do not understand the implications of a national health plan and are alarmed when we hear the words socialized medicine or national health plan, some out of ignorance and others on the grounds that the program will be costly and will lessen the quality of patient care not to mention the number of physicians who may find new ways to make a living. These same sentiments were especially visible during the Clinton Administration's failed attempt to implement a national health care plan. And now with the Obama administration we find ourselves hearing the same complaints.
I have heard people complaining about the extra cost and added taxes it would place on the people. Well and I am not saying I agree or disagree but wouldn't the added taxes that would be collected, replace insurance premiums, deductibles, co pays, and balanced billings? Could it be that on average, the amount of tax paid would be less than what individuals and families now pay for their health coverage? Is this true or not? I guess that would take a little investigative research on my part.
A large segment of our population worry about how it would affect their current coverage if President Obama has his way and we go with a type of universal health plan. What will happen to my Medicaid? Why nothing as far as I can tell since the system covers everyone, Medicaid would be unnecessary. What will happen to my Medicare ? Again Medicare would be unnecessary since everyone will be covered. It would definitely (I think now I haven't done a whole lot of research) be a life saver for the Self Employed since all citizens are covered. As it stands at present, small businesses would not suffer with large premiums because they have a small number of employees and it would no longer be a concern. As far as the big businesses are concerned it is my understanding that they will not be allowed to just arbitrarily drop their plans. Also, if you are happy with your present coverage you can keep it as well as the physician of your choice.
Of the top twenty four industrialized (modern)nations, the U. S. ranks twenty-first in infant mortality and sixteenthin life expectancy. Yet we spend more than 40 percent more per capita on health care than any other nation. And over 45.7 million Americans today are without any health care insurance, which means, of course, that many of us go without routine health care and so must frequent emergency rooms to obtain any help, a treatment which is much more costly than it would otherwise be. The other day I read that 60% of Bankruptcies filed in the United States are because of Medical bills. Ridiculous system, unfair system; there is no excuse for such a system in this day and age.
Some politicians say the system will end up like present day Medicare with a shortage of funds and then we will really be in trouble. How could our government run such a system just look at the trouble Medicare is in now with rampant fraud? Well I think fraud is something that goes on all the time in every program until we learn to put in better risk management systems. The truth is less than 3% of Medicaid or Medicare costs goes for administration. This low level of cost for the administration of two very large programs shows that the government can efficiently manage large programs.
In "socialized medicine," as in Sweden and Great Britain, doctors are salaried civil servants and the government itself (that is,the citizens) owns and operates most of the hospitals, with some others being run by non-profit organizations. With a "single-payer," or national health insurance plan, doctors are in private practice and most hospitals are not government owned and operated. Doctors and hospitals,as well as pharmaceutical and medical device companies, must negotiate their fees and charges with the government agency in charge of financing the plan and articulating its organization. In regard to the costs of drugs especially, this centralization is one of the reasons health carecosts are lower in single-payer systems, and it also explains why drug companies fight so hard against any single-payer plans. Does that really sound that bad a deal?
I know it will probably hurt the Pharmaceutical and health insurance industry but right now it seems the insurance industry is the only industry that is not hurting in our economy. Where is the justice in an industry in which the insurance companies are allowed to raise premiums, lower benefits and make obscene profits and bonuses in the millions to their CEO's. Yes, large numbers will lose their jobs in the insurance industry and also many assistants and lobbyists necessary to the administration of insurance industries' interests. However I am sure new jobs and industries will emerge to handle the change in the industry on this you can count on. Of course Physicians for a National Health Program say that by streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans. So I say enough already about socialized medicine let's do our research and pay attention and try and come up with what is best for all of us!
Tuesday, June 2, 2009
Who the Hell is Sally Medidtheftster?
Ok the reason we ask for your driver's license and other photo identification is because of The Red Flag Rules that have been adopted by the Federal Trade Commission (FTC). The Fair and Accurate Credit Transactions Act of 2003 has directed financial regulatory agencies, including the FTC to promulgate rules requiring "creditors" and "financial institutions" with covered accounts to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft. I know the terms "creditors" and "financial institutions" does not sound like a doctor's office does it? No it doesn't but we do extend credit.
Let me explain to you what can happen, has happened, and happens all too often in medical practices, labs and even hospitals all over the United States if your information cannot or has not been confirmed.
Let's say Sally Medidtheftster comes into the doctor's office, she signs in writing your name which for example is Patsy Wouldnotshowphotoid. I do not have a photo identification in the medical file for you Patsy Wouldnotshowphotoid. Somewhere, somehow Sally Medidtheftster knows additional information about you. Since I have no idea what you, Patsy look like, I have to assume that Sally is you. Now I take Sally back to the exam room. After Dr Unaware examines and runs lab tests on Sally who is pretending to be you, he discovers that Sally who is pretending to be you is Diabetic or has a sexually transmitted disease. Now this information is going to be put into your medical record. Yes I know it is not you but I had no way of determining who Patsy really was so I ended up putting all that incorrect medical information into your, Patsy's record.
Okay do you see where I am going with this? Now the real Patsy-who is you, comes in for a doctor's visit and suddenly she is asked if she has checked her blood sugars. You, Patsy respond with "what are you talking about I am not diabetic?" Then I have to say, "but you were just in a few months ago and we tested you and your labs came back positive for Diabetes."
Do you really expect me to know who you are? I see many patients daily. What if I am a new employee with this medical practice? However if I had a picture of you in the folder along with other personal identifiers, I would have known in the beginning that Sally was not you. Now on top of this confusion we not only have treated a person committing fraud (on your insurance I might add) we have entered incorrect medical information in your file. I could take it one step further and give you an example of what would have happened if you the real Patsy had been taken to the emergency room because of a car accident and our office had been contacted for your medical records. Your records show you are diabetic. So perhaps the reason for your confusion is not because you bumped your head on the dashboard in the car accident but because your sugar is low and according to your records; you have been prescribed insulin. Now the emergency room doctor gives you insulin per your medical records. Except oops you are not diabetic, that was Sally's information not yours. Except it is in your medical records! Now you are in a coma. Oh me oh my who is at fault? Is it the doctor for believing the information in your medical records? Could it be because you refused to cooperate at the front desk when asked to give information we needed so that we could protect your medical identity. Could it be that if we had a picture of you we would have known that the 5' 4", 267 pound blond who came in a few months ago was not the same 5'5" 250 pound brunette lying in a coma now? Yes it is an exaggeration but it could happen. Little things like comparing addresses, insurance information, pictures and other personal information can go a long way in helping us the medical practice protect you, the patient from this kind of scenerio.
There are numerous cases of uninsured patients being treated with someone else's insurance benefits. There are numerous cases of uninsured children being treated pretending to be the insured child of an insured subscriber. Imagine the time and money wasted correcting these kinds of mistakes. But more than anything imagine the lives that could be injured or lost because of incorrect medical information. So please don't be a Patsy Wouldnotshowphotoid. Do not ask us to make exceptions for you. Please do not ask our doctors to risk being fined for breaking the law.
Help us the medical office protect you and your medical identification and catch all those Sally Medidtheftsters! Oh Sorry Sally we need to catch those Johnny Medidtheftsters too!
http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm
Well when a patient does not pay their bill in full or a balance is left after insurance has paid and it is carried on the books that puts us in the position of "creditor". Therefore we fall under the auspices of the Red Flag Rules. However, that aside we are also responsible for making sure that the person who says they want to see the doctor is indeed that person. The only way to certify this to the best of our ability is to ask you the patient for your photo identification and other information that is applicable only to you. When we make a copy of your photo identification we put it into your medical file along with a copy of your insurance card. We also ask you to fill out what is called a demographic sheet, which asks for your address, telephone number, workplace, work number, person to be contacted in case of emergency, allergies, past surgeries, medications, physical history and so on.
This is to ensure that the next time someone comes in stating your name we will have something to compare with what we have on file with the information that is being given to us at check in. We will also ask you to give this information again if you tell us that there has been a change in your information or you have not been in a while or it has been longer than 3 years.Let me explain to you what can happen, has happened, and happens all too often in medical practices, labs and even hospitals all over the United States if your information cannot or has not been confirmed.
Let's say Sally Medidtheftster comes into the doctor's office, she signs in writing your name which for example is Patsy Wouldnotshowphotoid. I do not have a photo identification in the medical file for you Patsy Wouldnotshowphotoid. Somewhere, somehow Sally Medidtheftster knows additional information about you. Since I have no idea what you, Patsy look like, I have to assume that Sally is you. Now I take Sally back to the exam room. After Dr Unaware examines and runs lab tests on Sally who is pretending to be you, he discovers that Sally who is pretending to be you is Diabetic or has a sexually transmitted disease. Now this information is going to be put into your medical record. Yes I know it is not you but I had no way of determining who Patsy really was so I ended up putting all that incorrect medical information into your, Patsy's record.
Okay do you see where I am going with this? Now the real Patsy-who is you, comes in for a doctor's visit and suddenly she is asked if she has checked her blood sugars. You, Patsy respond with "what are you talking about I am not diabetic?" Then I have to say, "but you were just in a few months ago and we tested you and your labs came back positive for Diabetes."
Do you really expect me to know who you are? I see many patients daily. What if I am a new employee with this medical practice? However if I had a picture of you in the folder along with other personal identifiers, I would have known in the beginning that Sally was not you. Now on top of this confusion we not only have treated a person committing fraud (on your insurance I might add) we have entered incorrect medical information in your file. I could take it one step further and give you an example of what would have happened if you the real Patsy had been taken to the emergency room because of a car accident and our office had been contacted for your medical records. Your records show you are diabetic. So perhaps the reason for your confusion is not because you bumped your head on the dashboard in the car accident but because your sugar is low and according to your records; you have been prescribed insulin. Now the emergency room doctor gives you insulin per your medical records. Except oops you are not diabetic, that was Sally's information not yours. Except it is in your medical records! Now you are in a coma. Oh me oh my who is at fault? Is it the doctor for believing the information in your medical records? Could it be because you refused to cooperate at the front desk when asked to give information we needed so that we could protect your medical identity. Could it be that if we had a picture of you we would have known that the 5' 4", 267 pound blond who came in a few months ago was not the same 5'5" 250 pound brunette lying in a coma now? Yes it is an exaggeration but it could happen. Little things like comparing addresses, insurance information, pictures and other personal information can go a long way in helping us the medical practice protect you, the patient from this kind of scenerio.
There are numerous cases of uninsured patients being treated with someone else's insurance benefits. There are numerous cases of uninsured children being treated pretending to be the insured child of an insured subscriber. Imagine the time and money wasted correcting these kinds of mistakes. But more than anything imagine the lives that could be injured or lost because of incorrect medical information. So please don't be a Patsy Wouldnotshowphotoid. Do not ask us to make exceptions for you. Please do not ask our doctors to risk being fined for breaking the law.
Help us the medical office protect you and your medical identification and catch all those Sally Medidtheftsters! Oh Sorry Sally we need to catch those Johnny Medidtheftsters too!
http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm
Wednesday, May 13, 2009
Let's Blame the Doctors
Let's blame the doctors when we are asked to pay a co-pay and we say we don't have it and front desk wants to add a charge for having to send out a statement. It doesn't matter that we are fully aware that we are supposed to pay it. Let's just get mad. I mean we would never think to go anywhere else and not pay but no matter let's blame the doctors.
Let's blame the doctors when we have to sit in a waiting room full of hacking, nose blowing, throat snorkling patients blowing their fetid breath all over our personal space. How dare he/she take an extra few minutes to answer and comfort the patient in the exam room. Never mind he may be delivering devastating news. Hell! Let's just sit there and moan and groan about having had to sit in the waiting room and the doctor is at least 20 minutes late. Of course he/she had better take the time when our time comes even if it means taking an additional 15 minutes over the alloted time. If he doesn't- well let's blame the doctors for not taking the time to comfort and talk to us.
Let's blame the doctors when we cannot get an appointment for the same day. Even if we do not call and give a 24 hour cancellation notice as requested. Even if we do not bother to call if we are going to be late. Even if we set up a new patient appointment and don't bother to show and an hour of the doctor's time is wasted.
Let's blame the doctors and not the insurance companies for the rising cost of health care. Let's blame the doctors for the copays, the deductibles and out-of-pockets. Let's blame the doctors for not knowing our benefits.
Even though doctors take huge discount on all charges and the write off is ridiculous. Even though he/she may have monumental student loans from college and medical school to pay off. Even though doctors go to school for a very long time, even though doctors are expected to be perfect and not make mistakes, even though insurance companies don't pay them as they should and make their billing office beg for payment of even the most smallest service provided, even though doctors have to take discounts, writeoffs, put up with patients that are abusive,use their services like a free clinic, even though doctors have mortages to pay, rent to pay, staff to pay, benefits to pay, malpractice insurance to pay, even though their hold our very lives in their hands let's just blame the damn doctors!
Let's blame the doctors when we have to sit in a waiting room full of hacking, nose blowing, throat snorkling patients blowing their fetid breath all over our personal space. How dare he/she take an extra few minutes to answer and comfort the patient in the exam room. Never mind he may be delivering devastating news. Hell! Let's just sit there and moan and groan about having had to sit in the waiting room and the doctor is at least 20 minutes late. Of course he/she had better take the time when our time comes even if it means taking an additional 15 minutes over the alloted time. If he doesn't- well let's blame the doctors for not taking the time to comfort and talk to us.
Let's blame the doctors when we cannot get an appointment for the same day. Even if we do not call and give a 24 hour cancellation notice as requested. Even if we do not bother to call if we are going to be late. Even if we set up a new patient appointment and don't bother to show and an hour of the doctor's time is wasted.
Let's blame the doctors and not the insurance companies for the rising cost of health care. Let's blame the doctors for the copays, the deductibles and out-of-pockets. Let's blame the doctors for not knowing our benefits.
Even though doctors take huge discount on all charges and the write off is ridiculous. Even though he/she may have monumental student loans from college and medical school to pay off. Even though doctors go to school for a very long time, even though doctors are expected to be perfect and not make mistakes, even though insurance companies don't pay them as they should and make their billing office beg for payment of even the most smallest service provided, even though doctors have to take discounts, writeoffs, put up with patients that are abusive,use their services like a free clinic, even though doctors have mortages to pay, rent to pay, staff to pay, benefits to pay, malpractice insurance to pay, even though their hold our very lives in their hands let's just blame the damn doctors!
Monday, May 4, 2009
Free Medical Care -Is that the Answer?
The idea of having free health care sounds good actually but is it? Is it a good idea for the government to shoulder the cost of our health care? I mean we pay taxes don’t we? What is the definition of socialized health care? Some say the literal meaning is confined to systems in which the government operates health care facilities and employs health care professionals. According to Wikipedia “The term is often used in the U.S. to evoke negative sentiment toward public control of the health care system by associating it with socialism, which has negative connotations in American political culture. As such its usage is controversial”
Let’s explore how socialized medicine works in another country. Canada's health care is funded and delivered through a publicly-funded health care system, with most services provided by private entities. Under the terms of the Canada Health Act, the publicly funded insurance plans are required to pay for medically necessary care, but only if it is delivered in hospitals or by physicians. There is considerable variation across the provinces/territories as to the extent to which such costs as outpatient prescription drugs, physical therapy, long-term care, home care, dental care and even ambulance services are covered.
Considerable attention has been focused on two issues: wait times and health human resources. There is also a debate about the appropriate 'public-private mix' for both financing and delivering services. Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit.
These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate — even to patients who are not covered by the publicly funded system — unless the physician opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private.
The various levels of government pay for about 70% of Canadians' health care, although this number has decreased somewhat in recent years. The British North America Act did not give either the federal or provincial governments responsibility for health care, as it was then a minor concern. The Act did give the provinces responsibility for regulating hospitals, and the provinces claimed that their general responsibility for local and private matters encompassed health care.
The federal government felt that the health of the population fell under the Peace, Order, and Good Government part of its responsibilities. This led to several decades of debate over jurisdictions that were not resolved until the 1930s. Eventually the JCPC decided that the administration and delivery of health care was a provincial concern, but that the federal government also had the responsibility of protecting the health and well-being of the population.
Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers. There are also large private entities that can buy priority access to medical services in Canada, such as WCB in BC.
It would seem that we already have in a sense almost the same set up, with a few differences. We have Medicare and we have Medicaid. We have private insurance for those of us who can afford it. Of course we do not have a federal government that feels the health of the population falls under any type of government act or law. Medicare is money given back but paid in by the tax payer and Medicaid is money taken from the tax payers to support those who are not able to afford health insurance on their own, because of a multitude of reasons such as the elderly, disabled, and low-in-come Americans. Medicare coverage consists of two parts. Part A, which is financed largely through Social Security taxes, provides hospitalization insurance. Intended to assist people who need long-term medical treatment, Medicare Part A covers inpatient hospital services, skilled nursing facilities, home health services, and hospice care. Part B, which is financed through premiums paid by those who choose to enroll in the program, provides supplemental insurance to help cover the cost of physician services, outpatient hospital services, and medical equipment and supplies.
Medicaid provides medical assistance to 36 million low-income Americans. It was established through Title XIX of the Social Security Act of 1965 to pay the health care costs for members of society who otherwise could not afford treatment. The program is jointly funded by the federal government and the state governments, but is administered separately by each state within broad federal guidelines. Medicaid recipients include adults, children, and families, as well as elderly, blind, and disabled persons, who have low or no income and receive other forms of public assistance. Medicaid also covers the "medically needy," or those whose income is significantly reduced by large medical expenses. Medicaid covers the full cost of a wide range of medical services, including inpatient and outpatient hospital care, doctor visits, lab tests, X-rays, nursing home and home health care, family planning services, and preventative medicine. A large proportion of the Medicaid population is elderly or disabled, and thus also qualifies for Medicare. In these cases, Medicaid usually pays for Medicare premiums, deductibles, and co-payments, in addition to some non-covered services.
The problem is most insurance is only affordable for those of us who hold jobs, in which the employer pays the greater portion of the premium. Some of us who have pre-existing conditions or major chronic illnesses would not be able to afford insurance unless it is part of an employer benefit package. What about the self employed or the person who works with an employer who does not offer health insurance? What then? Certainly that person does not meet the qualifications of Medicare or Medicaid, and then what does him or she do? Well that person will join others in the system as uninsured. It is not surprising then that the idea of free health care is thus so appealing. But there are downsides to freebies. Here are some to name a few:
There is no incentive to be responsible for one’s health. It’s free I’ll wait until it becomes an issue and then I will go to the doctor who will give me some medicine and make me better.
Doctors and nurses would soon found areas of medicine that are not monopolized by the Federal Government. Then we would have a shortage of health care professionals.
Drug companies would cease to have competition and would soon not have the funds available for research and development of newer and better drugs. Soon only a few pharmaceutical companies would be in business and they would control the drug prices.
Free health care would become not “as good” as that which is paid for with private money and the rich would seek treatment elsewhere. The poor would wait needlessly for and receive substandard care a direct result of a system overburdened and underfunded.
If the government is controlling it then that means the politicians are handling it. And we know how that goes. Soon the lobbyists are pushing bills that benefit the select few who control the pharmaceutical companies and private medical facilities. Now after having said all of that do you really think free medical care is the solution or more of a mess than we already have now. Is there a solution we can all live with?
Information on Canada's Socialized Medical system taken from Wikopedia.
Let’s explore how socialized medicine works in another country. Canada's health care is funded and delivered through a publicly-funded health care system, with most services provided by private entities. Under the terms of the Canada Health Act, the publicly funded insurance plans are required to pay for medically necessary care, but only if it is delivered in hospitals or by physicians. There is considerable variation across the provinces/territories as to the extent to which such costs as outpatient prescription drugs, physical therapy, long-term care, home care, dental care and even ambulance services are covered.
Considerable attention has been focused on two issues: wait times and health human resources. There is also a debate about the appropriate 'public-private mix' for both financing and delivering services. Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit.
These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate — even to patients who are not covered by the publicly funded system — unless the physician opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private.
The various levels of government pay for about 70% of Canadians' health care, although this number has decreased somewhat in recent years. The British North America Act did not give either the federal or provincial governments responsibility for health care, as it was then a minor concern. The Act did give the provinces responsibility for regulating hospitals, and the provinces claimed that their general responsibility for local and private matters encompassed health care.
The federal government felt that the health of the population fell under the Peace, Order, and Good Government part of its responsibilities. This led to several decades of debate over jurisdictions that were not resolved until the 1930s. Eventually the JCPC decided that the administration and delivery of health care was a provincial concern, but that the federal government also had the responsibility of protecting the health and well-being of the population.
Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers. There are also large private entities that can buy priority access to medical services in Canada, such as WCB in BC.
It would seem that we already have in a sense almost the same set up, with a few differences. We have Medicare and we have Medicaid. We have private insurance for those of us who can afford it. Of course we do not have a federal government that feels the health of the population falls under any type of government act or law. Medicare is money given back but paid in by the tax payer and Medicaid is money taken from the tax payers to support those who are not able to afford health insurance on their own, because of a multitude of reasons such as the elderly, disabled, and low-in-come Americans. Medicare coverage consists of two parts. Part A, which is financed largely through Social Security taxes, provides hospitalization insurance. Intended to assist people who need long-term medical treatment, Medicare Part A covers inpatient hospital services, skilled nursing facilities, home health services, and hospice care. Part B, which is financed through premiums paid by those who choose to enroll in the program, provides supplemental insurance to help cover the cost of physician services, outpatient hospital services, and medical equipment and supplies.
Medicaid provides medical assistance to 36 million low-income Americans. It was established through Title XIX of the Social Security Act of 1965 to pay the health care costs for members of society who otherwise could not afford treatment. The program is jointly funded by the federal government and the state governments, but is administered separately by each state within broad federal guidelines. Medicaid recipients include adults, children, and families, as well as elderly, blind, and disabled persons, who have low or no income and receive other forms of public assistance. Medicaid also covers the "medically needy," or those whose income is significantly reduced by large medical expenses. Medicaid covers the full cost of a wide range of medical services, including inpatient and outpatient hospital care, doctor visits, lab tests, X-rays, nursing home and home health care, family planning services, and preventative medicine. A large proportion of the Medicaid population is elderly or disabled, and thus also qualifies for Medicare. In these cases, Medicaid usually pays for Medicare premiums, deductibles, and co-payments, in addition to some non-covered services.
The problem is most insurance is only affordable for those of us who hold jobs, in which the employer pays the greater portion of the premium. Some of us who have pre-existing conditions or major chronic illnesses would not be able to afford insurance unless it is part of an employer benefit package. What about the self employed or the person who works with an employer who does not offer health insurance? What then? Certainly that person does not meet the qualifications of Medicare or Medicaid, and then what does him or she do? Well that person will join others in the system as uninsured. It is not surprising then that the idea of free health care is thus so appealing. But there are downsides to freebies. Here are some to name a few:
There is no incentive to be responsible for one’s health. It’s free I’ll wait until it becomes an issue and then I will go to the doctor who will give me some medicine and make me better.
Doctors and nurses would soon found areas of medicine that are not monopolized by the Federal Government. Then we would have a shortage of health care professionals.
Drug companies would cease to have competition and would soon not have the funds available for research and development of newer and better drugs. Soon only a few pharmaceutical companies would be in business and they would control the drug prices.
Free health care would become not “as good” as that which is paid for with private money and the rich would seek treatment elsewhere. The poor would wait needlessly for and receive substandard care a direct result of a system overburdened and underfunded.
If the government is controlling it then that means the politicians are handling it. And we know how that goes. Soon the lobbyists are pushing bills that benefit the select few who control the pharmaceutical companies and private medical facilities. Now after having said all of that do you really think free medical care is the solution or more of a mess than we already have now. Is there a solution we can all live with?
Information on Canada's Socialized Medical system taken from Wikopedia.
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